Provider Demographics
NPI:1780741850
Name:COLORADO COUNSELING PROFESSIONALS, P.C.
Entity type:Organization
Organization Name:COLORADO COUNSELING PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-246-7559
Mailing Address - Street 1:3638 DINOSAUR ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3627
Mailing Address - Country:US
Mailing Address - Phone:303-246-7559
Mailing Address - Fax:303-831-9530
Practice Address - Street 1:9088 RIDGELINE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2383
Practice Address - Country:US
Practice Address - Phone:303-246-7559
Practice Address - Fax:303-831-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37473735Medicaid
CO803972Medicare PIN